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Assertive Community Treatment (ACT)

An Assertive Community Treatment (ACT) team consists of a community-based group of medical, behavioral health and rehabilitation professionals who use a team approach to meet the needs of an individual with severe and persistent mental illness. An individual who is appropriate for ACT does not benefit from receiving services across multiple, disconnected providers and may become at greater risk of hospitalization, homelessness, substance use, victimization and incarceration. An ACT team provides person-centered services addressing the breadth of an individual’s needs, helping him or her achieve their personal goals. Thus, a fundamental charge of ACT is to be the first-line (and generally sole provider) of all the services that an individual receiving ACT needs. Being the single point of responsibility necessitates a higher frequency and intensity of community-based contacts and a very low individual-to-staff ratio. Services are flexible; teams offer varying levels of care for all individuals receiving ACT and appropriately adjust service levels given an individual’s changing needs over time.

An ACT team assists an individual in advancing toward personal goals with a focus on enhancing community integration and regaining valued roles (example, worker, daughter, resident, spouse, tenant, or friend). Because an ACT team often works with individuals who may passively or actively resist services, an ACT team is expected to thoughtfully carry out planned assertive engagement techniques including rapport-building strategies, facilitating meeting basic needs and motivational interviewing techniques. These techniques are used to identify and focus on the individual’s life goals and what he or she is motivated to change. Likewise, it is the team’s responsibility to monitor the individual’s mental status and provide needed supports in a manner consistent with the individual’s level of need and functioning. The ACT team delivers all services according to a recovery-based philosophy of care. The team promotes self-determination, respects the person receiving ACT as an individual in his or her own right and engages peers in promoting hope that the individual can recover from mental illness and regain meaningful roles and relationships in the community.

Fidelity Evaluations

The State of North Carolina utilizes the “Tool for Measurement of Assertive Community Treatment (TMACT)” to measure teams’ fidelity adherence to the ACT model. The primary intention of a TMACT is to evaluate current practice, compare to best practice standards, conduct a needs assessment to guide recommendations and inform broader training needs and to highlight areas of strength.

Helpful Links

North Carolina Department of Health and Human Services: State-Funded ACT Service Definition
DMA ACT service definition
Institute for Best Practices, Center for Excellence in Community Mental Health, University of North Carolina at Chapel Hill